Individuals with ulcerative colitis (UC) have an increased risk for colorectal cancer when compared with the general population [Jess T et al. Clin Gastroenterol Hepatol. 2012]. Surveillance endoscopy to detect dysplastic lesions is critical in reducing this risk. Image-enhanced endoscopy offers improved resolution and lesion detection during surveillance endoscopy [Subramanian V, Ragunath K. Clin Gastroenterol Hepatol. 2014]. Advances in image enhancement include improving contrast using dye-based chromoendoscopy (CE), using virtual CE that relies on filters or software manipulation, or using autofluorescence endoscopy based on filter technology with software manipulation.

CE increased the detection of dysplasia during surveillance endoscopy as compared with standard-definition white light endoscopy (SDWLE) in a pooled analysis [Soetikno R et al. Gastroenterology. 2013]. High-definition white light endoscopy (HDWLE) improved detection rates for dysplasia about 2.5-fold when compared with SDWLE [Subramanian V et al. Inflamm Bowel Dis. 2013]. HDWLE detected dysplasia in 24 (11.5%) of 209 patients, whereas SDWLE detected dysplasia in 8 (5.0%) of 160 patients (prevalence ratio, 2.3; 95% CI, 1.03 to 5.11).

Venkat Subramanian, MD, St James University Hospital, Leeds, United Kingdom, presented the results of a randomized trial [NCT02138318] to compare the rate of detection of dysplasia in patients with long-standing (> 8 years of disease) UC using HDWLE compared with high-definition chromoendoscopy (HDCE).

Adults were included if they had long-standing extensive UC (extending proximal to splenic flexure) and a surveillance colonoscopy. Exclusion criteria were pregnancy, unwillingness or inability to give informed consent, or severe active colitis as assessed by the endoscopist at the time of the procedure.

For HDCE, 0.2% indigo carmine dye spray was used on withdrawal. Targeted and random biopsies from each colonic segment were taken from all patients. Patients randomly assigned to the HDWLE group (n = 53) were matched with those in the HDCE group (n = 50) for baseline demographics, including age, duration of disease, smoking status, presence of primary sclerosing cholangitis, family history of colorectal cancer, and use of 5-aminosalicylates or immunomodulators. About two-thirds of patients in the HDWLE group and about half the patients in the HDCE group were women. Results are shown in Table 1.

The increase in time for HDCE may be a result of the study’s mandate to collect random biopsies. Since all of the dysplastic lesions detected arose from targeted biopsies rather than random biopsies, Dr Subramanian suggested that random biopsies could be omitted in practice.

HDCE significantly improves the detection of dysplastic lesions in patients with long-standing extensive UC who are undergoing surveillance endoscopy. This method could become the procedure of choice for these patients and has been recommended in recent guidelines [Shergill AK et al. Gastrointest Endosc. 2015]. One limitation of the study was its single-center design in a small number of patients. To confirm these results, a study enrolling about 1600 participants across the United Kingdom is being initiated.